Arch adjustment appliance

ABSTRACT

The present disclosure provides method, systems, and devices for adjusting an arch of teeth. An appliance includes a removable shell formed of a first material having a number of cavities formed therein, wherein the number of cavities are shaped to receive teeth of a patient, and an arch element extending from the removable shell in a lingual direction and across at least a portion of the arch width of the removable shell, wherein the arch element is designed to expand an arch of the teeth of the patient, wherein the arch element has a width specific to a stage of a treatment plan.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.14/850,305, filed Sep. 10, 2015, which claims priority from U.S.Provisional Patent Application No. 62/052,893, each of which isincorporated herein by reference in its entirety for all purposes.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare incorporated herein by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

BACKGROUND

The present disclosure is related generally to the field of dentaltreatment. More particularly, the present disclosure is related tomethods, systems, and devices for adjusting an arch of a patient.

Dental treatments may involve, for instance, restorative and/ororthodontic procedures. Restorative procedures may be designed toimplant a dental prosthesis (e.g., a crown, bridge inlay, onlay, veneer,etc.) intraorally in a patient. Orthodontic procedures may includerepositioning misaligned teeth and/or changing bite configurations forimproved cosmetic appearance and/or dental function. Orthodonticrepositioning can be accomplished, for example, by applying controlledforces to one or more teeth over a period of time.

As an example, orthodontic repositioning may be provided through adental process that uses positioning appliances for realigning teeth.Such appliances may utilize a thin shell of material having resilientproperties, referred to as an “aligner,” that generally conforms to apatient's teeth but is slightly out of alignment with a current toothconfiguration.

Placement of such an appliance over the teeth may provide controlledforces in specific locations to gradually move the teeth into a newconfiguration. Repetition of this process with successive appliances inprogressive configurations can move the teeth through a series ofintermediate arrangements to a final desired arrangement.

Such systems typically utilize materials that are lightweight and/ortransparent to provide a set of appliances that can be used seriallysuch that as the teeth move, a new appliance can be implemented tofurther move the teeth toward the desired goal.

In some instances, the width of a dental arch of a patient's upperdentition and/or and a width of a dental arch of a patient's lowerdentition can be insufficient (e.g., too narrow) and on rare occasions,the width may be excessive (e.g., Brodie bite). A dental arch that isinsufficient can result in malocclusions such as crossbite, crowding ofteeth, impacted teeth, and/or the patient's smile may not beaesthetically pleasing in appearance. For instance, a patient's smilemay be “narrow”, resulting in a sunken appearance in the buccalcorridors due to the inability to see the back teeth from the frontview.

In certain types of front-to-back bite correction (e.g., Class II andClass III correction), a need for transverse width correction exists,without which the upper and lower arches will not be properlycoordinated. For Class II correction, the upper needs to be expanded sothat when the lower is advanced, the teeth in the buccal regions(typically the bicuspids and molars) are fitting together correctly inthe buccal-lingual dimension. For Class III correction, the reverse isrequired, and the lower needs to be expanded since it is usually the onethat has compensated for the Class III bite by constricting. When bothClass II and Class III are corrected to a more ideal Class I bite, therespective compensations need to be undone, and a transverse widthdimension of movement is necessary in addition to theanterior-to-posterior movement.

There are several ways in which the arch of a patient can be expanded.For example, palatal expansion expands the upper jaw of the patient byspreading the maxilla. In some situations, the teeth of the upper and/orlower jaw can be moved or angled outward thereby expanding the width ofthe arch of the patient. This technique can be referred to as dentalexpansion. Further, expansion of the lower arch in this manner is oftenreferred to as mandibular expansion.

In young patients, the midpalatal suture has not fused the left andright maxillary palates together and therefore, the movement of theplates with respect to each other can be accomplished more easily andwith less force than in older patients. When the fusing of the suture isnew, it may still be possible to split the suture apart.

For example, currently available orthodontic appliances can include ajackscrew and/or other mechanism that is employed to deliver ahorizontal stretching force to the molar teeth to split the upper jaw ofthe patient along the midpalatal suture. Such a mechanism typicallyspreads the left and right maxillary plates of the palate apart and thennew bone material grows in between to fill the gap. As such, a largehorizontal force (e.g., 10 to 50 Newtons (N) with cumulative loadsreaching 40 to 150 N across the suture) is applied during a shortperiod, in many cases. The insertion of such a mechanism is typicallyaccomplished by a treatment professional and can cause discomfort and/orpain for a patient.

In some instances, the screw and/or other mechanism can be employedincrementally one or more times a day (e.g., 0.25 mm expansion twice aday—one activation in the morning and once at night). For example, apinhole can be present in the orthodontic appliance and a patient caninsert an activation key into the pinhole to incrementally increase adistance between portions of the orthodontic appliance.

Such orthodontic appliances can be difficult for a patient to use, andoften require assistance from another person (e.g., a parent) to turnthe key. Not only are such appliances often not aesthetically pleasing,they often times interfere with the patient's speech, temporarily affecttheir ability to chew and/or swallow, and/or can be painful whenactivated.

Adding to the challenges of such an appliance is the need to retain theexpansion while the bone is filling into the suture, long after theactive expansion has taken place. The active expansion process may becompleted within 2 or 3 weeks' time, but the retention period can lastaround 6 months while waiting for the gap between the maxillary halvesto fill in with new bony tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe claims that follow. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1A illustrates an example of an appliance having a structuralreinforcement feature provided thereon according to a number ofembodiments of the present disclosure.

FIG. 1B illustrates another example of an appliance having a structuralreinforcement feature provided thereon according to a number ofembodiments of the present disclosure.

FIG. 2 illustrates an example of an appliance embodiment according tothe present disclosure.

FIG. 3 illustrates virtual model of an appliance according to a numberof embodiments of the present disclosure.

FIG. 4 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.

FIG. 5 illustrates an example of an appliance having a structuralreinforcement material according to one or more embodiments of thepresent disclosure.

FIG. 6A illustrates an example of an appliance having a removable archelement according to a number of embodiments of the present disclosure.

FIG. 6B illustrates an example of an appliance having a removable archelement according to a number of embodiments of the present disclosure.

FIG. 7 illustrates an example of an appliance having an anterior tabarch element according to a number of embodiments of the presentdisclosure.

FIG. 8 illustrates an example of an appliance having a rib featureaccording to a number of embodiments of the present disclosure.

FIG. 9 illustrates an example of an appliance having an arch elementconnecting the posterior sides of the arch according to a number ofembodiments of the present disclosure.

FIG. 10 illustrates an example of an appliance having a full palatalarch element according to a number of embodiments of the presentdisclosure.

FIG. 11 illustrates an example of an appliance having an extendedgingival feature thereon according to a number of embodiments of thepresent disclosure.

FIG. 12A illustrates an example of an appliance according to a number ofembodiments of the present disclosure.

FIG. 12B illustrates an example of an appliance according to a number ofembodiments of the present disclosure.

FIG. 12C illustrates an example of an appliance according to a number ofembodiments of the present disclosure.

DETAILED DESCRIPTION

As discussed above, the present disclosure provides methods, systems,and devices for expanding an arch of a patient. Generally, dental and/orskeletal expansion occurs during an orthodontic treatment which is aprocess of moving and reorienting teeth for functional and/or aestheticpurposes, although repositioning may be made for other purposes.

In some instances, an arch of a patient's teeth can be insufficient(e.g., narrow), and in rare occasions, too wide. An insufficient arch ofa patient's teeth can cause overcrowding of a patient's teeth, impactedteeth, speech difficulty, breathing issues, and/or the smile of apatient can be aesthetically unpleasing. As such, an orthodontictreatment plan can include an arch expansion component and such aprocess typically occurs in an early stage of the plan in order toprovide more room for the teeth to be arranged.

A narrow arch also prevents the anterior-posterior bite relationshipfrom being corrected properly. An arch of teeth, as used herein, caninclude a curved row of teeth on a particular jaw of a patient. Aninsufficient arch can include an arch that has a width too narrow tosupport the row of teeth in a correct alignment, for instance. The archwidth of a patient's teeth can be expanded, for instance, using anorthodontic appliance (e.g., a dental appliance).

As discussed above, patients that are children or teenagers may have amaxilla where the midpalatal suture has not yet fused. Usually in themid to late teens, the palatal suture fuses and the halves of themaxilla join together to become a single maxillary bone.

The maxilla (e.g., the upper jaw) is a bone that is fixed to the skulland forms the palate of the patient. The mandible (e.g., lower jaw) is abone that is also attached to the skull by numerous muscles which powerits movement. The mandible articulates at its posterior upwardextremities with the temporal bone to form the jaw joint. The jaw jointis a loosely connected joint that accommodates the variety of movementsof the mandible relative to the maxilla during biting and chewing.

In correctly shaped and positioned jaws, the upper teeth occupy an archthat is wider than the arch comprising the lower teeth. In other words,the upper teeth are designed to be buccally positioned relative to theteeth in the lower jaw. Malocclusions, such as crossbite, occur whenthis normal arrangement is reversed and one or more of the upper teethare positioned lingual to the teeth in the lower jaw.

A patient with an un-fused maxilla can, for instance, have their palateskeletally expanded. This is in contrast to dental expansion where theteeth are uprighted or moved within the boundaries of the jaw in whichthey are contained. With skeletal expansion, the underlying bone ismoved and the teeth are moved along with the changes to the shape of thebone.

Expanding a palate can, for instance, include splitting the left andright sides of the maxilla so that the teeth on the upper left side moveas a single unit relative to the teeth on the right side. Because ofthis phenomenon, a gap between the top two front teeth can open upduring the expansion process if they are not restrained from separating.

As discussed above, expansion of the palate, such as those methodsperformed prior to an orthodontic treatment involving braces and wires,currently includes having a treatment professional place an orthodonticappliance that may include anchoring bands, support bars, springs,and/or jack screws. The appliance is firmly affixed to the teeth at theanchor points and the springs or jackscrew applies forces on the teethin order to move the underlying portions of the palate of the patient,thereby causing the arch of the patient's dentition to widen.

To adjust the appliance and increase the amount of expansion, thepatient and/or another person must insert a key into the pinhole andturn the key to increase the width of the orthodontic appliances. Insome examples, prior approaches can include a removable appliance whichcontains a jackscrew expander that is activated with a pinhole key.

After expanding the arch of the patient to the desired width (andsometimes overcorrecting in order to anticipate potential relapse towardthe narrowness initially present), further orthodontic treatment can beperformed to move and re-orient the teeth of the patient. This type ofadditional orthodontic treatment is typically performed after theexpansion phase and a retention period where the jaw position isstabilized for a period of time while the musculature and bone adjust tothe new positioning.

Further, palate expansion devices that are used primarily for skeletalexpansion are typically temporarily anchored to the molars and/orpre-molars of the patient for the duration of the expansion and cannotbe removed except by a dental professional because they are cementedinto place. The forces that are applied to the molars and/or premolarsare rather high in order to separate the suture during a short timeperiod (e.g., one or more days), and therefore, the treatment can beuncomfortable to the patient due to the high pressure that is generatedduring the activation period. Once the suture splits, the majority ofthe pressure is relieved and subsequent activations in close proximityto the initial activation are not as uncomfortable.

In contrast, expanding an arch of a patient (whether skeletally with afixed appliance or dentally with a removable appliance) according toembodiments of the present disclosure, can include utilizing a set ofone or more appliances, such as positioners, retainers, and/or otherremovable appliances (e.g., clear plastic polymer shells and/oraligners) having a shell to be worn over the teeth of a patient andhaving an arch element thereon that is designed to expand an arch ofteeth of the patient by: moving the teeth of the patient to a widerposition within the jaw, by expanding the palate of the patient, or acombination of the two. As indicated, some embodiments discussed hereinmay also expand the palate to a degree, but the dental expansion is muchmore gradual (e.g., on the order of 0.5 mm per month as opposed to 0.5mm per day).

Palatal expansion may be accomplished, for example, in patients wherethe midpalatal suture has not fused. Additionally, some embodiments maybe able to un-fuse the suture, in some patients.

One or more appliance embodiments can include a removable shell formedof a first material having a number of cavities therein, wherein thecavities are shaped to receive teeth of the patient. These appliancesare not fixed to the teeth of the patient and therefore can be removedby the patient for periods of time during treatment without aid fromother people or intervention by a treatment professional.

In various embodiments of the present disclosure, an arch element (e.g.,a trans-palatal arch element as illustrated in the embodiments of FIGS.9 and 10 or a mandibular arch element as illustrated in the embodimentsof FIGS. 7 and 11) can extend from the removable shell and across atleast a portion of the arch width of the removable shell. The arch widthcan be from molar to molar, from premolar to premolar, from canine tocanine, or from any tooth on the left side to any tooth on the rightside.

In mandibular arch elements, the arch can extend along the inside of theteeth in the anterior area of the patient's mouth, as shown in FIGS. 7and 11. In palatal arch elements, the arch element can extend across thepalate (trans-palatal) and can extend across at the posterior, anterior,in parts of one or the other, or in both areas of the patient's mouth.

In some embodiments, the arch element can be formed of a first materialand from a second material that is a different than the first materialin at least one physical property. For example, the first material maybe a polyurethane material and the second material also be apolyurethane material with the same chemical formula, but of differenthardness or rigidity due to greater crosslinking. Or, the first materialcan be of one chemical composition (e.g. polyurethane), and the secondmaterial of an entirely different chemical composition (e.g. polyvinylchloride).

In some embodiments, the second material is more resilient than thefirst material. This can be beneficial in embodiments, for example,where there is an initial need for a more rigid arch element and then amore resilient arch element later in treatment, among other situationswhere such an embodiment may be utilized.

The arch element can have a width specific to a stage of a treatmentplan and can be designed to expand an arch of the teeth of the patientto that specified width, which may be less than the full width in whichthat arch is to be expanded (i.e., the arch expansion can beincrementally accomplished by expanding the arch a little at a time overthe use of several differently designed sequential dental appliances).Or the arch may be over-expanded to compensate for incomplete biologicalresponse to the desired outcome, where the actual width of the teeth isless than the width programmed or built into the stage(s) of thetreatment plan which can provide a constant transverse expansion forceto achieve slow palatal expansion.

For example, rather than providing a strong force, such as 10 to 50 Nfor a short period of a few days to a few weeks, embodiments of thepresent disclosure can provide a lesser force, such as 3 to 9 N, for alonger period, such as a month to six months. This force can be used,for example, to move palatal plates, move teeth outward, and/or maintainthe teeth and/or jaw in a particular orientation while musculature andbone are adjusting to the orientation and to prevent movement of theteeth or jaw back toward their initial orientation.

In some embodiments, the second material can include, for instance, amore rigid material than the first material designed to provide greaterresistance and/or force in a horizontal direction (i.e., transversedirection) against the posterior teeth (e.g., molars and bicuspids) ofthe arch of the patient. In various embodiments, this second materialcan be designed to impart force to the molars and/or other teeth on thejaw of the patient in order to either help preserve or change thetransverse dimensions of the arch. Additionally, in some embodiments,with the use of appliances on the upper and lower jaws, the force can beimparted to parts of the opposing jaw (e.g., teeth, jaw bone, etc.).

The expansion of an arch of teeth in the patient can be used to treatmalocclusions such as crossbites, sagittal problems, crowding, and/or tohelp prevent or resolve impacted teeth, in various embodiments. Thetransverse support elements can be designed to not interfere with theshells of the dental appliance. In this manner, a dental appliance inaccordance with embodiments of the present disclosure can be used toconcurrently expand or constrict an arch of the patient whilerepositioning a number of teeth of the patient.

For example, in some embodiments, the shell of the dental appliance canbe used to provide force on one or more teeth to change their locationor orientation. Embodiments of the present disclosure can be utilized totreat Class I, Class II, and Class II malocclusions.

For instance, with Class I malocclusions, teeth of the patient areinserted into cavities in the shell and the shell applies force to oneor more teeth to change their location or orientations. With Class II(overbite or overjet) and Class III (underbite) malocclusions, theappliance can include other features, such as cut outs (areas cut out ofthe appliance shell material to allow access to the tooth surfacethrough the appliance or to form, for example, a hook to attach aresilient member (e.g., an elastic band material) between the upper andlower jaw, to for instance treat a overbite or overjet.

As discussed above, in some embodiments, a plurality of appliances canbe worn by a patient successively to achieve gradual expansion (orconstriction) of the arch of teeth in the patient. For instance, each ofa plurality of dental appliances can include an incrementally widerwidth to expand the arch of the patient in incremental distances. Insome such embodiments, since this arch expansion technique can beaccomplished concurrently with other orthodontic treatments, the archexpansion can be accomplished over a series of appliances that will beutilized, for example, over a period of less than six months, therebymaking any pain and/or discomfort of the patient more consistent andless arbitrary without prolonging the overall time for orthodontictreatment.

In some embodiments, an appliance can be formed using a thermoformingprocess. For instance, a first portion of an arch element can be formedof a material using a virtual model of the palate of the patient and avirtual model of a number of teeth of the patient.

The first portion of the arch element can be wider than the arch widthof the number of teeth of the first jaw of the patient and can be shapedto substantially follow contours of the palate of the patient. Forexpansion, this difference in the width will facilitate the movement ofthe arch outward toward the wider position of the arch elementgenerating a transverse expansion force.

A removable shell can be formed over a set of molded teeth. Theremovable shell can include a number of cavities formed therein andshaped to receive the number of teeth of patient and a second portion ofthe arch element. The second portion of the arch element can be formedof the same material as the removable shell and can include the samewidth as the first portion of the arch element.

The first portion of the arch element and the second portion of the archelement can, for example, be connected to form the dental appliance. Thefirst portion and second portion can be connected, in accordance withvarious embodiments of the present disclosure, for example, bythermoforming the removable shell over the set of molded teeth with thefirst portion of the arch element placed within the set of molded teeth(e.g., encapsulated), or via direct fabrication of the arch elementsfrom a virtual model, then by fusing the two materials together (e.g.,ultrasonic welding), by adhering the first portion and the secondportion using an agent subsequent to forming the first portion and theremovable shell, and/or by adding a number of features to the firstportion of the arch element (e.g., as discussed further herein).

In this manner, a dental appliance can be formed that has two distinctmaterial properties, but is unitary in nature (e.g., forms a single bodythat can be used by the patient even though it is formed of twomaterials). Such embodiments, are discussed with regard to theembodiments illustrated in the figures and discussed below.

In the detailed description of the present disclosure, reference is madeto the accompanying drawings that form a part hereof, and in which isshown by way of illustration how one or more embodiments of thedisclosure may be practiced. These embodiments are described insufficient detail to enable those of ordinary skill in the art topractice the embodiments of this disclosure, and it is to be understoodthat other embodiments may be utilized and that process, electrical,and/or structural changes may be made without departing from the scopeof the present disclosure. As used herein, “a number of a particularthing can refer to one or more of such things (e.g., a number of teethcan refer to one or more teeth).

The figures herein follow a numbering convention in which the firstdigit or digits correspond to the drawing figure number and theremaining digits identify an element or component in the drawing.Similar elements or components between different figures may beidentified by the use of similar digits. For example, 104 may referenceelement “04” in FIG. 1A, and a similar element may be referenced as 304in FIG. 3. As will be appreciated, elements shown in the variousembodiments herein can be added, exchanged, and/or eliminated so as toprovide a number of additional embodiments of the present disclosure. Inaddition, as will be appreciated, the proportion and the relative scaleof the elements provided in the figures are intended to illustratecertain embodiments of the present invention, and should not be taken ina limiting sense.

FIG. 1A illustrates an example of an appliance according to a number ofembodiments of the present disclosure. The appliance 100, illustrated inthe embodiment of FIG. 1A, can include an upper dentition appliance(e.g., an appliance placed on the upper jaw of the patient). An upperjaw can include a maxilla and can include a number of teeth of apatient's upper dentition. The lower jaw can include a mandible and caninclude a number of teeth of the patent's lower dentition.

Appliances can include any positioners, retainers, and/or otherremovable dental appliances for finishing and maintaining teethpositioning in connection with a dental treatment. These appliances maybe utilized by the treatment professional in performing a treatmentplan. For example, a treatment plan can include the use of a set ofappliances, created according to models described herein. Appliances, insome embodiments, can include flexible dental appliances which serve, inpart, as a prosthesis for esthetics and/or dental function.

An appliance can, for example, be fabricated from a polymeric shell,and/or formed from other material, having a cavity shaped to receive andapply force to reposition one or more teeth from one teeth arrangementto a successive teeth arrangement. The shell may be designed to fit overa number of, or in many instances all, teeth present in the upper and/orlower jaw. The shell can include an interior surface (e.g., adjacent toa surface of the teeth place therein) and an exterior surface. Theinterior surface is configured to receive and a apply forces to theteeth therein to reposition a number of teeth of the patient, forexample.

In accordance with some embodiments of the present disclosure, theappliance 100 can include a removable shell 102 formed of a firstmaterial having a number of cavities formed therein. As discussed above,the number of cavities can be shaped to receive teeth of the patient.

The appliance 100 can include an arch element 104 extending from theremovable shell 102 in a lingual direction and across an arch width ofthe removable shell 102. The arch width of the removable shell 102, asused herein, is a space between the cavities of the removable shell 102.For instance, the arch element 104 can expand across a surface of themouth of the patient when the dental appliance 100 is placed over theteeth of the patient. The surface of the mouth can include, forinstance, a palate and/or floor of the mouth.

The arch element, as illustrated by FIG. 1A, can be formed of the firstmaterial and a structural reinforcement feature thereon. As definedherein, a structural reinforcement feature can be any structure thatincreases the rigidity of a portion of the appliance or increases one ormore force vectors (force provided in X, Y, and/or Z axial directions).In one example, with respect to the embodiment of FIG. 1A, the archelement 104 includes areas that are corrugated 106.

As discussed above, the arch element can be designed to expand an archof teeth of the patient. For instance, the width of the arch element canbe wider than the actual arch width of the teeth of the patient in orderto define the desired arch width incremental target for the teeth. Anarch width of the teeth of the patient can include a distance betweenteeth of the left posterior side of the patient's dentition and teeth ofthe right posterior side of the patient's dentition. As an example, thearch element can be 0.25 millimeters wider than the arch width of theteeth of the patient.

The element 104 as shown is designed to provide structural reinforcementto the posterior section but also allows flexibility in the anteriorsection, for example, if anterior transverse force is not desired. Anadvantage of this flexibility would be to ease the insertion force.

In some embodiments, the arch element, or a portion thereof, can be madefrom a second material that can be different in at least one materialproperty (e.g., chemical property of a material, weight of materialused, mixture of chemicals used, etc.) than the first material. Forinstance, the rigidity of the second material can apply a force to atleast a portion of the number of teeth in a transverse direction (e.g.,horizontal direction) to expand the arch of teeth of the patient.

In some embodiments, the first material of the arch element can form afirst layer and the second material of the arch element can form asecond layer (e.g., as illustrated in the embodiment of FIG. 5). Thefirst layer of the first material can be formed integrally with and of asame material as the removable shell 102, for instance. The second layerof the second material can be formed in a separate process and attachedto the first layer of the first material, for example (e.g., asdiscussed further herein).

In some embodiments, the arch element can follow contours of a surfaceof the mouth of the patient when the appliance 100 is placed over theteeth of the patient. For example, the arch element can be shaped tosubstantially follow the contours of the palate of the patient. This canbe accomplished, for example, by taking a mold or scan of the surface ofthe palate of the patient and then forming the surface of arch elementto substantially match the mold/scan surface (i.e., the surface may notbe identical, as the arch element may be designed to be wider asdiscussed above and therefore is not an identical copy of the mold/scansurface, and therefore may substantially match, but not be identical).

The contours of the palate in the appliance may be interpolated inanticipation of a stretching of the tissues during the expansion, inorder to better accommodate the seating of the appliance in thepatient's mouth. In other words, the shape of the appliance is designedto include an expected stretching of the patient's palatal or lowerlingual tissues during dental expansion, and not just a movement of theteeth.

In some embodiments, one side of the arch element 104, can be adjacentto and/or in contact with a tongue of the patient. The other side of thearch element can, for example, be adjacent to and/or in contact with asurface of the patient's mouth (e.g., the palate and/or floor of thepatient's mouth). Further, as discussed herein, in some embodiments,using the patient's mouth mold and/or scan data, the trans-palatal archmay be designed to contact the palate (e.g., if more support is desired)or it may be designed not to have contact (e.g., for patient comfort).

The appliance 100 can be used for repositioning the number of teeth ofthe patient concurrently with expansion of the arch of teeth of thepatient utilizing the arch element. The expansion of the arch of teethcan include movement of posterior teeth (e.g., molars) and/or otherteeth of the arch of the patient in a transverse direction and/orstretching of the maxillary suture of the patient (e.g., separates themaxillary halves in the region of the suture), along with a stretchingof the surrounding soft tissues (e.g., the palatal gingiva) during theexpansion.

The simultaneous treatment of misalignment of a patient's dental arch(e.g., insufficient dental arch width) in conjunction with teethalignment issues (e.g., rotation, tipping, etc.) can, for example,potentially eliminate a second phase of a two phase treatment protocol,make the second phase less complex or a little more comfortable for thepatient, shorten treatment times when compared to current lineartwo-phase treatment protocols that first treat the misalignment of apatient's dental arch followed by treatment of misalignment of thepatient's teeth. That is, the arch element can, in accordance with anumber of embodiments, avoid and/or not interfere with engagement of theremovable shell 102 with the teeth therein and thereby allow forcorrection of various tooth misalignment issues during the archexpansion process so that both arch expansion and alignment correctionoccurs in tandem rather than as separate phases.

Although the present embodiment of FIG. 1A illustrates an appliance foran upper dentition of a patient, embodiments are not so limited.Appliances, in accordance with some embodiments, can include anappliance for a lower dentition of a patient and/or an appliance for anupper dentition and a lower dentition.

In some such embodiments, the arch element extending from a surface ofan appliance for a lower dentition can substantially follow the contoursof a portion of the floor of the patient's mouth. While the lower arch(i.e., mandible) does not contain a suture that can be split as theupper arch does, the same principles of appliance design describedherein may be applied even in the lower in order impart greatertransverse stability and/or force through the lower arch appliance tomore effectively deliver transverse forces to the lower dentition fordental expansion purposes.

In some such embodiments, since a generally horizontal span across thebottom of the patient's mouth may not be suitable for positioning of anarch element (e.g., because the tongue is in the way), an appliance ofthe present disclosure may include reinforced portions of the dentalappliance that impart forces to help dentally expand the lower arch ofthe patient. For example, a portion of the arch element may bepositioned in front of the tongue of the patient or in close proximityto the tongue in order to impart a horizontal force and the shell may bedesigned to transfer or redirect the resulting anterior force generatedby the tongue towards the back portion of the jaw of the patient (e.g.,closer to the molars).

In some embodiments, a first appliance can be placed over the upperdentition and a second appliance can be placed over the lower dentitionof the patient. The first appliance and the second appliance can eachhave an arch element.

The arch element of the first appliance and the arch element of thesecond appliance can expand the dental arch of the upper dentition andthe dental arch of the lower dentition, respectively, to the samedegree. Or in the case of Class II or Class III correction where adisproportionate amount of expansion/constriction is needed, the amountscan be coordinated so that the expansion targeted is suitable for thedesired amount of anterior-posterior bite change.

In some embodiments of the present disclosure, the appliance 100 can bea portion of a treatment plan. For instance, the treatment plan caninclude a series of appliances designed to incrementally implement atreatment plan. Each of the series of appliances can be a stage of theincremental treatment plan, for instance. The series can be used fortreating misalignment of teeth of a patient and/or misalignment of oneor more arches of teeth of the patient. In some such embodiments, onearch can be expanded while the other arch is not expanded or both archescan be expanded simultaneously. Or one arch can be expanded while theother one is constricted.

For instance, a first appliance, of a series of appliances designed toincrementally implement a treatment plan can comprise a first shellformed of a first material having a plurality of cavities thereindesigned to receive teeth of a first jaw. The first appliance caninclude a first arch element formed of a first layer of the firstmaterial and a second layer of the second material different than thefirst material.

The first arch element can extend from the first shell across an archwidth of the first shell. For instance, the first arch element can havea first width specific to a first stage of the treatment plan and/or canbe designed to expand an arch of the teeth of the patient.

A second appliance, of the series of appliances, can comprise a secondshell having a plurality of cavities therein designed to receive teethof the first jaw. The second appliance can include a second archelement. For example, the second arch element can have a second widthspecific to a second stage of the treatment plan.

The second width can be wider than the first width. For instance, thesecond width can include an incremental increase in width as compared tothe first width. The successive incremental increase in the arch widthof the appliances corresponds to the desired gradual increase in theactual physical arch of the patient.

In accordance with some embodiments of the present disclosure, theseries of appliances can include a third appliance. The third appliancecan include a third shell having a plurality of cavities thereindesigned to receive teeth of the second jaw (e.g., the lower jaw). Forinstance, the third appliance can include a third arch element designedto expand the arch of teeth of the patient. The third arch element canhave a third width specific to the first stage of the treatment plan.

In such an embodiment, the first appliance and third appliance can befor a first stage of the treatment plan. For instance, a patient canplace the first appliance over the teeth of the first jaw (e.g., upperjaw) and can place the third appliance over the teeth of the second jaw(e.g., lower jaw). The first arch element of the first appliance and thethird arch element of the third appliance can be designed to expand thearch of teeth of the first jaw and the arch of teeth of the second jawto a same degree (e.g., equal distance) based on the first width and thesecond width. Equal distance in expansion amount is desirable if theupper and lower arches are already in good coordination and nofront-to-back change in the bite is desired or planned.

In various embodiments, the series of appliances can include a fourthappliance. The fourth appliance can include a fourth shell having aplurality of cavities therein designed to receive teeth of the firstjaw. The fourth appliance may not include an arch element and/or caninclude a fourth arch element, for example.

Although the present embodiments illustrate two stages of a treatmentplan, embodiments in accordance with the present disclosure are not solimited. Treatment plans can include a variety of number of stages,including more or less than two treatment stages. At least a portion ofthe stages can include treatment for gradual expansion of an arch ofteeth of a patient. Alternatively and/or in addition, one or more of thestages may not include arch elements, in various embodiments.

In an example embodiment, a system can include: a first appliance, of aseries of appliances designed to incrementally implement a treatmentplan, having an arch element shaped to span at least a portion of thesurface of a patient's palate, wherein the arch element is designed toexpand an arch of the teeth of the patient, wherein the arch element hasa width specific to a first stage of the treatment plan and one or moretooth engagement structures and wherein each structure contacts at leastone of a surface of a tooth or a surface of the patient's gingiva andimparts a force thereto. A second appliance, of the series ofappliances, can include: a second arch element shaped to span at least aportion of the surface of a patient's palate, wherein the second archelement is designed to expand the arch of the teeth of the patient,wherein the arch element has a width specific to a second stage of thetreatment plan and one or more tooth engagement structures and whereineach structure contacts at least one of a surface of a tooth or asurface of the patient's gingiva and imparts a force thereto.

FIG. 1B illustrates an example of an appliance according to a number ofembodiments of the present disclosure. Similar to the embodimentillustrated in FIG. 1A, the appliance 100, illustrated in the embodimentof FIG. 1B, can be utilized as an upper dentition appliance (e.g., anappliance placed on the upper jaw of the patient).

In accordance with some embodiments of the present disclosure, theappliance 100 can include a removable shell 102 formed of a firstmaterial having a number of cavities formed therein. As discussed above,the number of cavities can be shaped to receive teeth of the patient.

The appliance 100 can include an arch element 103 extending from theremovable shell 102 in a lingual direction and across at least a portionof the arch width of the removable shell 102. The arch width of theremovable shell 102, as used herein, is a space between the cavities ofthe removable shell 102.

For instance, the arch element 103 can span across a surface of themouth of the patient when the dental appliance 100 is placed over theteeth of the patient. The surface of the mouth can include, forinstance, a palate and/or floor of the mouth. In such an embodiment, thearch element is designed to expand an arch of the teeth of the patient,wherein the arch element has a width specific to a stage of a treatmentplan. Accordingly, in some embodiments, the width of the arch element iswider than an arch width of the teeth of the patient.

The arch element, as illustrated by FIG. 1B, can be fabricated having astructural reinforcement feature thereon. In the example of FIG. 1B, anumber of ridges and valleys 105 are formed on the arch element 103.

The ridge and valley structure 105 can be used to provide additionalrigidity to the arch element which can allow more force to be provided.In this manner, the dental appliance can be utilized to perform moreapplications, such as to move palatal plates, move teeth outward, and/ormaintain the teeth and/or jaw in a particular orientation whilemusculature and bone are adjusting to the orientation and to preventmovement of the teeth or jaw back toward their initial orientation.

Although two examples of structural reinforcement features areillustrated in FIGS. 1A and 1B, any suitable structural reinforcementfeature can be utilized that will increase the rigidity of the archelement.

FIG. 2 illustrates an example of an appliance embodiment according tothe present disclosure. In the embodiment of FIG. 2, the shell 202 ofthe appliance 200 has cavities to accept less than all of the teeth ofthe patient's jaw. For instance, in FIG. 2, the appliance has cavitiesfor the molars of the patient. This can be beneficial as it will onlyapply for to those teeth, thereby focusing the forces imparted by theappliance to those teeth that are in need of adjustment at this stage inthe patient's treatment. In the embodiment of FIG. 2, the appliance hasan arch element 204 with a smooth surface. Embodiments of the presentdisclosure can be created in a variety of ways.

For example, in some embodiments, an arch element can be formed of amaterial using a virtual model of a palate of a patient and a virtualmodel of a number of teeth of the patient. The arch element can be widerthan an arch width of the number of teeth of the first jaw of thepatient, specific to a stage of a treatment plan, and can be shaped tosubstantially follow contours of the palate of the patient (that mayalso include modeling of anticipated changes to the palatal contours dueto tissue stretching), for instance.

The palatal contours in the model can also be specifically raised in avertical direction so that any appliance which is formed over the modelis slightly raised in comparison to the actual contours of the palate.In other words, a slight gap between the actual palate and the palatalcoverage portion of the appliance can be designed to be present. Thisgap allows the transverse benefits of the appliance design to be ineffect while not necessarily requiring an exact fit of the appliance tothe contours of the tissue.

A slight offset in the vertical dimension can minimize any disruption inspeech, swallowing, or feel due to changes in tongue position that mayresult in the alteration. More importantly, intentionally raising thevertical dimension of only the palatal tissue regions has the benefit ofnot needing perfect modeling of any non-linear stretching that mighttake place in the tissue. This can greatly reduce the risk ofuncomfortable pressure spots and sores caused by the appliance. Havingto relieve pressure spots in the appliance can be very time consumingfor the doctor, and if the appliance is thin to begin with, suchadjustments can lead to weakened areas in the appliance.

A virtual model of a number of teeth of the patient can, for example,include an initial virtual dental model and/or an intermediate virtualdental model. A virtual model of the palate (and/or other tissuesurfaces of the patient's mouth) can include the contours of the palate.In some embodiments, the virtual model of the palate and the virtualmodel of the number of teeth can include a single virtual model and/ortwo separate virtual models.

The arch element can be formed by a rapid prototyping process, such as,for example, by a Computer-aided manufacturing (CAM) milling,stereolithography, 3D printing, fused deposition modeling (FDM),selective laser sintering (SLS), and/or photolithography. Advantages ofsuch techniques can include, for example, that multiple materials can beused in a single build, various cross sectional thickness's can bedesigned and built for rigidity, and easy fabrication of a complexorganic geometry.

The arch element can be shaped to fit between the arch of the first jawof the patient while being sized to be wider than the arch width of thenumber of teeth of the first jaw of the patient.

In some embodiments, the flexibility of the appliance is such that itcan be compressed in the transverse direction during seating in order toactivate the expansion force. This force then gets released and directedtowards the teeth, soft tissues, and/or jaw bone when then the applianceis seated in the mouth.

As discussed above, in some embodiments, the arch element can be shapedto substantially follow contours of the palate of the patient using thevirtual model of the palate. Alternatively and/or in addition, the archelement can be shaped to substantially follow contours of the floor ofthe mouth of the patient using a virtual model of the floor of themouth.

To form an appliance, a removable shell can, for example, be formed overa set of molded teeth. The removable shell can include a number ofcavities formed therein, wherein the number of cavities are shaped toreceive the number of teeth of the patient. In various embodiments, theremovable shell can include a second portion of the arch element formedof the same material as the number of cavities. The second portion ofthe arch element can be formed integrally with and/or during a sameprocess as the number of cavities, for instance.

The material forming the first portion of the arch element can be morerigid than the material forming the second portion of the arch element,for instance. In some embodiments, the second portion of the archelement can include the same width as the first portion of the archelement.

Alternatively and/or in addition, the first portion of the arch elementcan be designed to be adjacent to and/or in contact with a surface ofthe patient's mouth (e.g., the palate and/or floor of the patient'smouth) when the dental appliance is placed over the teeth of thepatient. The second portion of the arch element can be designed to beadjacent to and/or in contact with a tongue of the patient when thedental appliance is placed over the teeth of the patient.

The dental appliance can be made, for example, by thermoforming a pieceof plastic over a physical dental model. The physical dental model, forinstance, can represent an incremental position to which a patient'steeth are to be moved. This desired position of the patient's teethincludes any underlying desired changes to the skeletal structure whichholds the teeth in place.

The physical dental models can be manufactured by downloading aComputer-aided Design (CAD) virtual dental model file into a rapidprototyping process, such as, for example, a Computer-aidedmanufacturing (CAM) milling, stereolithography, 3D printing, fuseddeposition modeling (FDM), selective laser sintering (SLS), and/orphotolithography. Advantages of such techniques can include, forexample, that multiple materials can be used in a single build, variouscross sectional thickness's can be designed and built for rigidity, andeasy fabrication of a complex organic geometry. The virtual dental modelcan be hollowed out or “shelled” before it is sent for manufacturing tosave on material cost if printed, for example.

The dental model (e.g., set of molded teeth) can be created from avirtual model of a number of teeth of a patient. A dental model can beformed in accordance with a unique treatment file that identifies apatient, a stage of a treatment plan, the virtual model of the number ofteeth, and/or whether the dental model is of the upper and/or lowerdental arch.

In some embodiments, a treatment file can be accessed by a rapidprototyping apparatus machine, such as a SLA or printing, to form and/orcreate the dental model. The result of the dental model can include aset of molded teeth (e.g., a physical set of molded teeth). The set ofmolded teeth can include at least a replica of a number of teeth of thepatient. The dental model can be used to make a dental appliance, forexample, by creating a negative impression of the dental model usingpolymeric sheets of material and vacuum forming heated sheets of thepolymer over the dental model, as discussed above.

For instance, a dental appliance can be created by layering athermoformable sheet of material and/or multiple sheets of one or morematerials over the dental model. The materials can include at least onepolymeric material, for instance.

Generally, the dental appliance can be produced and/or formed, forexample, by heating the polymeric thermoformable sheet and vacuum orpressure forming the sheet over the dental model (i.e., over a number ofthe teeth in the mold). The shape of the sheet of material can bedesigned to intentionally vary in thickness in some portions of thesheet (beyond natural variations in thickness during the shapingprocess) as it conforms to the mold shape. A dental appliance can, forexample, include a negative impression of the dental model. Theappliance and/or parts thereof may be transparent, semi-transparent, oropaque in such a way as to emulate a natural tooth shade.

FIG. 3 illustrates virtual model of an appliance according to a numberof embodiments of the present disclosure. As illustrated by theembodiment of FIG. 3, the virtual dental appliance 300 can include aremovable shell 302, an arch element 304.

The removable shell 302 can include a number of cavities formed therein,wherein the number of cavities are shaped to receive the number of teethof the patient. The removable shell 302, as illustrated in FIG. 3, caninclude a virtual removable shell, a physical removable shell, and/ormaterial to be thermoformed over a dental model (e.g., as discussedfurther herein).

The model of the lower jaw, can include a virtual model of a surface ofthe mouth of the patient including a virtual model of the number ofteeth of patient. The virtual model (e.g., the model of the lower jaw)can be used to print and/or mill the arch element.

Alternatively and/or in addition, the model of the lower jaw can includea physical set of molded teeth. A physical set of molded teeth can becreated, for instance, utilizing a virtual model of the surface of themouth and/or the teeth of the patient. The removable shell 302 can beformed over a physical set of molded teeth, in various embodiments.

FIG. 4 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.For instance, a computing device 424 can have a number of componentscoupled thereto. The computing device 424 can include a processor 426and a memory 428. The memory 428 can have various types of informationincluding data 430 and executable instructions 432, as discussed herein.

The processor 426 can execute instructions 432 that are stored on aninternal or external non-transitory computer device readable medium(CRM). A non-transitory CRM, as used herein, can include volatile and/ornon-volatile memory. Volatile memory can include memory that dependsupon power to store information, such as various types of dynamic randomaccess memory (DRAM), among others. Non-volatile memory can includememory that does not depend upon power to store information.

Memory 428 and/or the processor 426 may be located on the computingdevice 424 or off the computing device 424, in some embodiments. Assuch, as illustrated in the embodiment of FIG. 4, the computing device424 can include a network interface 434. Such an interface 434 can allowfor processing on another networked computing device, can be used toobtain information about the patient, and/or can be used to obtain dataand/or executable instructions for use with various embodiments providedherein.

As illustrated in the embodiment of FIG. 4, the computing device 424 caninclude one or more input and/or output interfaces 438. Such interfaces438 can be used to connect the computing device 424 with one or moreinput and/or output devices 440, 442, 444, 446, 448.

For example, in the embodiment illustrated in FIG. 4, the input and/oroutput devices can include a scanning device 440, a camera dock 442, aninput device 444 (e.g., a mouse, a keyboard, etc.), a display device 446(e.g., a monitor), a printer 448, and/or one or more other inputdevices. The input/output interfaces 438 can receive executableinstructions and/or data, storable in the data storage device (e.g.,memory), representing a virtual dental model of a patient's dentition.

In some embodiments, the scanning device 440 can be configured to scanone or more physical dental models of a patient's dentition. In one ormore embodiments, the scanning device 440 can be configured to scan thepatient's dentition and/or dental appliance directly. The scanningdevice 440 can be configured to input data into the computing device424.

In some embodiments, the camera dock 442 can receive an input from animaging device (e.g., a 2D or 3D imaging device) such as a virtualcamera, a printed photograph scanner, and/or other suitable imagingdevice. The input from the imaging device can, for example, be stored inmemory 428.

The processor 426 can execute instructions to provide a visualindication of a treatment plan, a dental appliance, and/or a portion ofan arch element on the display 446. The computing device 424 can beconfigured to allow a treatment professional or other user to inputtreatment goals. Input received can be sent to the processor 426 as data430 and/or can be stored in memory 428.

Such connectivity can allow for the input and/or output of data and/orinstructions among other types of information. Some embodiments may bedistributed among various computing devices within one or more networks,and such systems as illustrated in FIG. 4 can be beneficial in allowingfor the capture, calculation, and/or analysis of information discussedherein.

The processor 426, in association with the data storage device (e.g.,memory 428), can be associated with the data 430. The processor 426, inassociation with the memory 428, can store and/or utilize data 430and/or execute instructions 432 for designing a virtual appliance for aspecific stage of a treatment plan and/or a series of virtual appliancesfor a treatment plan. Such data can include the virtual dental modeland/or virtual model of a surface of a patient's mouth (e.g., palateand/or floor of the mouth).

The processor 426 coupled to the memory 428 can cause the computingdevice 424 to perform a method including, for example, providing avirtual model of a dental appliance having a shell configured toreposition a number of teeth of a patient. The virtual model of thedental appliance can include a second portion of an arch element. Invarious embodiments of the present disclosure, the processor 426 coupledto the memory 428 can cause the computing device 424 to perform themethod including providing a virtual model of a first portion of an archelement (e.g., as illustrated in FIG. 3).

The virtual model of the dental appliance can, in some embodiments, beused to create a physical dental appliance. For example, dentalappliance structural data can be stored in memory and used by anappliance manufacturing device to fabricate an appliance based upon thedental structural data. For instance, the memory can contain executableinstructions to operate a thermoforming or direct fabrication device toform a dental appliance using those techniques.

As discussed above, in some embodiments, the arch element, or a portionthereof, can be made from a second material that can be more rigid thanthe first material. For instance, the rigidity of the second materialcan apply a force to at least a portion of the number of teeth in atransverse direction (e.g., horizontal direction) to expand the arch ofteeth of the patient. In some embodiments, the rigidity of the secondmaterial can generate a necessary palatal expansion force to un-fuse thesuture of the maxilla and/or move the portions of the maxilla withrespect to each other, among other uses as discussed herein.

In some embodiments, the first material of the arch element can form afirst layer and the second material of the arch element can form asecond layer (e.g., as illustrated in the embodiment of FIG. 5). Thefirst layer of the first material can be formed integrally with and of asame material as the removable shell 102, for instance.

The second layer of the second material can be fabricated in a separateprocess and attached to the first layer of the first material, forexample (e.g., as discussed further herein). In some embodiments, thesecond layer may be the same thickness or a thicker layer of thematerial of the first layer. In such embodiments, these two layers canbe referred to as a first portion and a second portion of the archelement.

The first portion and the second portion of the arch element can bewider than the arch width of the number of teeth of the first jaw of thepatient. For instance, the arch element can be shaped to substantiallyfollow contours of the palate of the patient and/or the floor of themouth of the patient, in some embodiments. The palatal contour in themodel can be raised in order to result in a uniform relief gap betweenthe appliance and the actual contour of the palate. The physical firstportion can be formed of a material that is more rigid than the materialforming the second portion.

In some embodiments, in order to direct force from the arch element toother portions of the shell, a more rigid material may be appliedbetween the arch element and other portions of the shell (e.g., a rigidmaterial is applied over and/or under the shell material or encapsulatedwithin layers of shell material). Additionally, the rigid material usedto form the arch element and/or force directing portions can bereinforced by a reinforcement material (e.g., a metallic sheet or wirematerial provided to the second material).

In one example method embodiment, the method of forming a dentalappliance, includes: forming a first virtual arch element using physicaldata of a palate and a number of teeth of a patient, wherein the archelement is wider than an arch width of the number of teeth of a firstjaw of the patient, specific to a stage of a treatment plan and formingone or more virtual tooth engagement structures connected to the archelement and wherein each structure contacts a surface of a virtual toothand imparts a virtual force thereto. Such embodiments can furtherinclude forming a second virtual arch element using physical data of apalate and a number of teeth of a patient, wherein the second archelement corresponds impart a force on one or more teeth according to asecond stage of the treatment plan and replacing the first virtual archelement with the second virtual arch element.

The second virtual arch element can be formed, for example, by usingphysical data of a palate and a number of teeth of a patient, whereinthe second arch element corresponds impart a force on one or more teethaccording to a second stage of the treatment plan. Second one or morevirtual tooth engagement structures connected to the second virtual archelement using physical data of a palate and a number of teeth of apatient can be formed, wherein the second one or more tooth engagementstructures correspond to move one or more teeth according to a secondstage of the treatment plan.

In some embodiments, prior to forming the second one or more virtualtooth engagement structures that correspond to move one or more teethaccording to a second stage of the treatment plan, the location of theteeth is calculated based upon a movement of an arch of the patientaccomplished by one or more estimated forces applied by the first archelement and first one or more virtual tooth engagement structures. Thiscan be beneficial in better matching the virtual adjustment of thepatient's mouth to what will actually occur in the patient's mouth,among other benefits.

In some embodiments, the method can further include defining a spacebetween two virtual teeth or a virtual tooth and another feature of apatient's mouth based upon a calculated movement of an arch of thepatient accomplished by one or more estimated forces applied by thefirst arch element and first one or more virtual tooth engagementstructures and designing the second virtual tooth engagement structuresto maintain the defined space. This can be beneficial wherein a spacewill be needed at a later time in treatment and/or as teeth areerupting, among other benefits.

As noted herein in some embodiments, the virtual appliance or datatherefrom can be used to fabricate a physical appliance to be used in apatient's mouth. For example, in some embodiments, a method can furtherinclude forming a physical arch element based on the virtual archelement and one or more physical tooth engagement structures connectedto the arch element and wherein each structure contacts a surface of avirtual tooth of a patient and imparts a virtual force thereto.

It should be noted that when first and second are used to describe itemsin this disclosure, it is only meant that one item comes before the nextand does not indicate that the items be the first and second items in aseries of multiple items. For example, a first item may be the thirditem in a series of items and the second item may be the sixth item in aseries and the terms first and second are used to indicate that thefirst comes before the second in the series even though there may bemore items in the series.

FIG. 5 illustrates an example of an appliance having a structuralreinforcement material according to one or more embodiments of thepresent disclosure. In the embodiment of FIG. 5, the appliance 500 isshown at two different perspectives. The arch element 504 includesmultiple materials (e.g., a first material layer which, in this case, isthe same type of material as the shell 502, and a second material layer508, which is a different material).

The first portion of the arch element can be connected to the secondportion of the arch element to form the dental appliance. The archelement can, for example, be designed to provide a force to at least aportion of the number of teeth in a transverse direction to expand thearch of the teeth of the first jaw of the patient.

The first portion of the arch element and the second portion of the archelement can be connected in a variety of ways, in accordance with someembodiments of the present disclosure. For instance, the first portionof the arch element can be connected to the second portion of the archelement by thermoforming the removable shell over the set of moldedteeth with the first portion of the arch element placed within the setof molded teeth (i.e., encapsulated by).

In some embodiments, an agent (e.g., a binding material) can be added toconnect the first portion of the arch element to the second portion ofthe arch element created by thermoforming the removable shell. The firstand second portions may also be secured to each other through ultrasonicwelding or other techniques that allow adhesion without the need for anintermediary substrate such as a solvent or adhesive.

In accordance with some embodiments of the present disclosure, the firstportion of the arch element can be connected to the second portion ofthe arch element by adhering the first portion and the second portionsubsequent to forming the first portion of the arch element and theremovable shell. In some embodiments, an agent can be utilized to causethe first portion of the arch element to adhere to the second portion ofthe arch element, however, in some embodiments, multiple materials usedto form the first portion and second portion may be bonded without theuse of an agent (e.g. ultrasonic welding, laser spot welding). The firstportion can also be cured into place in direct contact with the dentalmodel (e.g. a liquid resin such as polyacrylic painted onto the modeland subsequently hardened through chemical or light cure) and thenjoined to the second material which is thermoformed over the firstmaterial to create an adherent bond between the two materials.

In various embodiments, the first portion can include a number offeatures (e.g., as discussed further herein). Connecting the firstportion to the second portion of the arch element can includethermoforming the removable shell over the set of molded teeth with thefirst portion of the arch element placed within the set of molded teeth.The thermoformed material (i.e., the material the removable shell isformed of) can surround the number of features of the first portion ofthe arch element to connect the first portion to the second portion ofthe arch element.

The removable shell 502 can include the number of cavities and a secondportion of the arch element 506. The second portion of the arch element506 can be formed concurrently with and/or of the same material as thecavities, for instance, using the model of the lower jaw. The materialforming the first portion of the arch element 504 can be more rigid thanthe material forming the second portion of the arch element 506.

The first portion of the arch element 504 can be connected to the secondportion of the arch element 506 to form a dental appliance. For example,the first portion of the arch element 504 can be placed within thephysical set of molded teeth (e.g., the model of the lower jaw). Anagent can be added to the second portion of the arch element. The firstportion of the arch element 504 and the second portion of the archelement 506 can be connected as the removable shell 502 is thermoformedover the set of molded teeth. That is, the first portion of the blockelement 504 can be encapsulated in the set of molded teeth and can beadhered to the second portion of the arch element 506 utilizing anagent.

Alternatively, the first portion of the arch element 504 can beconnected to the second portion of the arch element 506 subsequent toforming the first portion of the arch element 504 and the removableshell 502. For instance, the removable shell 502 can be thermoformedover the physical set of molded teeth. Subsequently, the first portionof the arch element 504 can be adhered to the second portion of the archelement 506. The portions of the arch element 504, 506 can be adheredusing an agent or through means not requiring an agent (such asultrasonic welding), for instance.

Some embodiments of the present disclosure can be provided in multipleparts. This can be beneficial, for example, where the palate has beenexpanded, but the movement of teeth, by the cavities and other appliancestructures is still ongoing. In such cases, an appliance such as thatshown in FIG. 6A or 6B, may be suitable.

FIGS. 6A and 6B illustrate an example of an appliance having a removablearch element according to a number of embodiments of the presentdisclosure. In the embodiments of FIGS. 6A and 6B, the appliance 600 hasa shell 602 with a mounting element 610 (as shown in FIG. 6A) thereon toengage the arch element 604.

The mounting element and arch element can be affixed together by anysuitable mechanism and can be either releasably or permanently affixedtogether. Some examples of affixation mechanisms include, sliding aflange into a slot, placing a tab into an aperture, chemical bonding,adhesive bonding, among many other affixation mechanisms. In theembodiment of FIG. 6A, the edges of the arch element that will beadjacent to the shell can be slid into a notch or channel formed in theshell (the embodiment of FIG. 6A has a raised channel formed therein).This engagement can be mechanically fixed (by a locking mechanism orfrictional engagement or by bonding the two parts together chemically orwith an adhesive.

In the embodiment of FIG. 6B, an arch element 603 is attached to a shell602 to form an appliance 600. In this embodiment, the arch element 603is formed from a material different than that of shell 602.

Materials having different characteristics can be added or in someembodiments, one arch element can be interchanged with another. Forexample, if it is desired that the arch element be more rigid than theshell, then a more rigid material may be used (as in this embodiment) oradded as a layer (to an arch element of one or more other materials,such as that of FIG. 6A or FIG. 9) to add rigidity to the arch element.In another embodiment, the arch portion of the appliance may alreadyhave rigidity, but may lose its rigidity over time, so an arch elementof a different material can be added to provide resiliency which mayextend the period in which the original arch material may be usable forits purpose.

In various embodiments, a first arch element can be used and then asecond arch element having a different characteristic may be affixed inplace of the first arch element. For example, an arch element having afirst force providing physical characteristic may be utilized and thenthat arch element may be removed from the appliance and replaced by anarch element having a second force providing characteristic. This can bebeneficial in embodiments where the shell can be reused from one phaseof treatment to another and as such, the arch element can be replacedrather than an entirely new appliance having to be fabricated and used.The different characteristic can be different from one or both of theshell and/or the first arch element. Examples of different physicalcharacteristics include: rigidity, resiliency, color, and thicknessprofile (thickness at any point along the second arch element may bedifferent than the thickness at a corresponding point on the first archelement).

In some embodiments, the arch element can be removed and the appliancecan continue to be worn in the patient's mouth without the arch element.In such embodiments, the appliance can, for example, continue tomaintain the position of one or more teeth and/or can continue to adjustthe position and/or orientation of one or more teeth.

FIG. 7 illustrates an example of an appliance having an anterior tabarch element according to a number of embodiments of the presentdisclosure. FIG. 7 provides an appliance 700 having a shell 702 with atab 705 thereon to provide additional rigidity and/or palate expansionforce. The anterior tab 705 is a small tab on lingual side of arch. Itmay be used to increase structural integrity of the appliance in thetransverse direction between the two ends of the jaw. In someembodiments, lingual tab feature may run along one or more portions ofor the entire span of arch. The cross sectional geometry of the lingualtab can be varied uniformly or non-uniformly along its length to provideadditional rigidity and/or force to adjust the palate.

FIG. 8 illustrates an example of an appliance having a rib featureaccording to a number of embodiments of the present disclosure. FIG. 8provides an appliance 800 that has one or more rib features 807 on thesurface of the shell 802. These features are areas that are thicker thanother portions of the appliance body thickness and therefore provideaddition rigidity and/or force.

Additionally, the ribs are elongate shapes that can be oriented indifferent directions along the surface of the shell 802. This enablesthem to provide forces in specialized directions to precision the forcesprovided to the teeth from the appliance. In the illustrated embodiment,of FIG. 8, the ribs have been thermoformed in a particular geometry(planned through the aid of the executable instructions in the computingdevice) to provide added rigidity to the posterior section of the dentalappliance.

For example, in some embodiments, a rib feature can be positioned in thebuccal and/or lingual sections between the cavities for the crowns tostrengthen the appliance in the transverse direction, so individualteeth can be moved as a segment. In a mixed dentition case, if a primarytooth is lost during treatment, such an embodiment can help preserve thepalatal expansion force, since the posterior section is being expandedas a segment.

FIG. 9 illustrates an example of an appliance having an arch elementconnecting the posterior sides of the arch according to a number ofembodiments of the present disclosure. In the embodiment of FIG. 9, theappliance 900 includes a shell 902 with an arch element 904 spanningacross the palate. In this embodiment, the arch element 904 does notcover the entire palate of the patient, but rather, spans a portion ofthe palate and leaving a portion uncovered. Such an embodiment may bemore comfortable for the patient and may be easier to place and remove,among other benefits.

FIG. 10 illustrates an example of an appliance having a full palatalarch element according to a number of embodiments of the presentdisclosure. In the embodiment of FIG. 10, the appliance 1000 includes ashell 1002 with an arch element 1004 spans the entire palate surface (inthe anterior-posterior direction between the left and right jaw portionsof the shell 1002. In this embodiment, the arch element 1004 spans theentire palate of the patient (up to the back edge if the back molars orthe molars that are second from the back). Such an embodiment may beeasier to manufacture and will reduce edges that may be uncomfortable tothe patient, among other benefits.

FIG. 11 illustrates an example of an appliance having an extendedgingival feature thereon according to a number of embodiments of thepresent disclosure. The embodiment of FIG. 11 provides an appliance 1100including a shell 1102 having an extended gingival feature 1109 toprovide additional rigidity and/or palate expansion force.

The extended gingival feature 1109 is an extension of the appliance thatis contoured to follow the shape of the gingiva. This type of archelement may be used to increase structural integrity of the appliance inthe transverse direction between the two ends of the jaw. In someembodiments, extended gingival feature may run along one or moreportions of or the entire span of arch.

Further, the cross sectional geometry of the extended gingival featurecan be varied uniformly or non-uniformly along its length to provideadditional rigidity and/or force to adjust the palate. For example, theextended gingival feature can be shaped to match the contour (e.g., intwo or three dimensions) of the physical gingiva upon which the extendedgingival feature will be placed.

The extension of the gingival cut line at the time of manufacturing mayaccomplish what the anterior tab feature does by using the actualgingival surface to support the transverse force to increase therigidity of the appliance and/or provide force to adjust the palate inthe transverse direction. This feature may also help with applianceretention for short crowns found in mixed dentition cases, among otherbenefits.

Embodiments of the present disclosure can also provide other beneficialfunctions. For example, embodiments can maintain space in the patient'smouth when the patient's primary and permanent dentition have a sizediscrepancy.

For instance, unlike the anterior teeth, the permanent premolars may besmaller than the primary teeth they replace. On average, the mandibularprimary second molar is 2 mm larger than the second premolar and, in themaxillary arch, the primary second molar is only 1.5 mm larger. Theprimary first molar is only 0.5 mm larger than the first premolar.Accordingly, on average, this results in 2.5 mm of space, called leewayspace, in the mandibular arch and 1.5 mm in the maxillary arch. Theleeway space is usually taken by mesial movement of the permanent molars(the permanent first molars move mesially relatively rapidly).

This creates an opportunity to gain arch length and relieve crowding bystopping the first molar mesial movement by, for example, using a ponticalong with the appliance by filling the appliance tooth space andleaving clearance for erupting tooth. The filled pontic material can beused to keep the first molar from moving into the leeway space whileallowing the permanent premolar to erupt.

FIGS. 12A, 12B, and 12C illustrate examples of appliances according to anumber of embodiments of the present disclosure. In the embodiment ofFIG. 12A, an appliance 1200 has one or more tooth engagement structures,in this case, a shell 1202 with cavities, and an arch element 1204formed thereon. Also illustrated in the embodiment of FIG. 12 A arestructural reinforcement features in the form of struts 1214. Thesefeatures can be positioned in various places on the arch element toincrease the rigidity of the arch element.

This may be a design that can be produced directly from a virtual model,through processes as discussed above, either as a single piece or as oneor more shell and arch pieces that can be affixed together. In theembodiment of FIG. 12B, the appliance 1200 does not have a shell, butrather has an arch element 1204 and one or more tooth engagementstructures 1210 to contact a surface of a tooth and impart forcethereto.

It should be noted that in some embodiments, portions of the appliancemay not be visible to people when they see the appliance in thepatient's mouth and as such the material does not have to be clear, andthis therefore allows for more options with regard to the choice ofmaterial that can be utilized. With some manufacturing processes, asdiscussed herein, the appliance can be fabricated from multiplematerials or can be manufactured in parts wherein the parts are madefrom different materials and are attached together to create theappliance.

The tooth engagement structure may extend along a small portion of theside surfaces of the tooth or may extend substantially around the sidesurfaces of the tooth, as shown in FIG. 12C. In the embodiment of FIG.12C, the tooth engagement structures 1212 extend around the entire sidesurfaces of the tooth to surround the tooth.

Such embodiments may provide more secure fitment of the appliance in themouth of the patient, may be able to impart more force, and may be ableto control that application of that force in one or more directions withrespect to the tooth. This may, in some instances, allow the position ororientation of a tooth to be adjusted while the appliance is expandingthe palate of the patient.

In some embodiments, the appliance can be overlayed over an existingappliance used to adjust tooth positioning and/or orientation. Forexample, in an embodiment such as the one illustrated in FIG. 12A, thecavities 1202 can be sized to fit over cavities of an aligner applianceused for aligning one or more teeth or a retainer appliance used tomaintain the position of one or more teeth. The aligner appliance and/orthe arch adjustment appliance may have features thereon to lock the twoappliances together or they may be affixed together by other means(e.g., frictionally and/or via adhesives, etc.).

As discussed herein, multiple piece embodiments can be potentiallybeneficial, for example, because they can be designed to have aremovable portion. For instance, the lingual side connection feature canbe affixed (e.g., thermoformed) on the surface of the appliance. A rigidpiece, spanning across the palate, can be snapped into place and removedas needed. Alternatively, in some embodiments, a wire or spring can beused instead of the rigid piece.

In embodiments where the pieces are permanently affixed, a lingual sideconnection feature can be affixed (e.g., thermoformed) on the surface ofthe appliance to position a rigid piece spanning across the palate so itcan be secured to an appliance (e.g., with adhesive). Alternatively, awire or spring can be used instead of the rigid piece, in someembodiments.

In one such embodiment, the appliance includes an arch element shaped tospan at least a portion of the surface of a patient's palate, whereinthe arch element is designed to expand an arch of the teeth of thepatient, wherein the arch element has a width specific to a stage of atreatment plan and one or more tooth engagement structures and whereineach structure contacts at least one of a surface of a tooth or asurface of the patient's gingiva and imparts a force thereto. In somesuch embodiments, one or more tooth engagement structures is a removableshell having a number of cavities formed therein, wherein the number ofcavities are shaped to receive teeth of a patient.

As shown in FIG. 12B, the tooth engagement structure can extend along aportion of at least one side surface of a tooth. Further, in theembodiments of FIGS. 12A and 12C, the tooth engagement structure canextend substantially around the side surfaces of the tooth (in theembodiments of FIGS. 12A and 12C it extends all the way around) tosurround the tooth.

Although the discussion above is focused on arch expansion, in someinstances the arch will need to be contracted and embodiments of thepresent disclosure can be utilized for arch contraction cases as well.For example, in a method embodiment, the method can include a method offorming a dental appliance, including forming a first virtual archelement using physical data of a palate and a number of teeth of apatient, wherein the arch element is narrower than an arch width of thenumber of teeth of a first jaw of the patient, specific to a stage of atreatment plan, forming one or more virtual tooth engagement structuresconnected to the arch element and wherein each structure contacts asurface of a virtual tooth and imparts a virtual force thereto. Invarious embodiments such as those illustrated in the Figures, the toothengagement structure can be constructed and arranged to impart force tomove the tooth either positionally or orientationally or both while theappliance is adjusting (i.e., expanding or contracting) the palate ofthe patient.

Other benefits of embodiments of the present disclosure can include, butare not limited to: arch form control wherein the appliance hasstructural integrity to modify or control mandible or maxilla shape. Theuse of an upper and lower appliance set allows for alignment of the archshape in either or both arches. Embodiments can also provide structuralintegrity to enhance and control growth as a patient matures, amongother benefits.

Although specific embodiments have been illustrated and describedherein, those of ordinary skill in the art will appreciate that anyarrangement calculated to achieve the same techniques can be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments of thedisclosure.

It is to be understood that the above description has been made in anillustrative fashion, and not a restrictive one. Combination of theabove embodiments, and other embodiments not specifically describedherein will be apparent to those of skill in the art upon reviewing theabove description. The scope of the various embodiments of thedisclosure includes any other applications in which the above structuresand methods are used. Therefore, the scope of various embodiments of thedisclosure should be determined with reference to the appended claims,along with the full range of equivalents to which such claims areentitled.

In the foregoing Detailed Description, various features are groupedtogether in example embodiments illustrated in the figures for thepurpose of streamlining the disclosure. This method of disclosure is notto be interpreted as reflecting an intention that the embodiments of thedisclosure require more features than are expressly recited in eachclaim.

Rather, as the following claims reflect, inventive subject matter liesin less than all features of a single disclosed embodiment. Thus, thefollowing claims are hereby incorporated into the Detailed Description,with each claim standing on its own as a separate embodiment.

What is claimed is:
 1. A method of forming a dental appliance,comprising: forming a virtual arch element using physical data of apalate and a number of teeth of a patient, wherein the virtual archelement is wider than an arch width of the number of teeth of a firstjaw of the patient, specific to a stage of a treatment plan; and formingone or more virtual tooth engagement structures connected to the virtualarch element, and wherein each virtual tooth engagement structurecontacts a surface of a virtual tooth and imparts a virtual forcethereto.
 2. The method of claim 1, wherein forming the one or morevirtual tooth engagement structures includes forming a removable shellthat includes a number of cavities formed therein, wherein the number ofcavities are shaped to each receive one or more teeth of the patient. 3.The method of claim 1, wherein the virtual arch element is a firstvirtual arch element, the method further including forming a secondvirtual arch element using physical data of a palate and a number ofteeth of a patient, wherein the second arch element corresponds impart aforce on one or more teeth according to a second stage of the treatmentplan and replacing the first virtual arch element with the secondvirtual arch element.
 4. The method of claim 1, wherein the virtual archelement is a first virtual arch element and the one or more virtualtooth engagement structures is a first one or more virtual toothengagement structures, the method further including: forming a secondvirtual arch element using physical data of a palate and a number ofteeth of a patient, wherein the second arch element corresponds impart aforce on one or more teeth according to a second stage of the treatmentplan; and forming a second one or more virtual tooth engagementstructures connected to the second virtual arch element using physicaldata of a palate and a number of teeth of a patient, wherein the secondone or more tooth engagement structures correspond to move one or moreteeth according to the second stage of the treatment plan.
 5. The methodof claim 4, further including, prior to forming the second one or morevirtual tooth engagement structures that correspond to move one or moreteeth according to a second stage of the treatment plan, calculating thelocation of the teeth based upon a movement of an arch of the patientaccomplished by one or more estimated forces applied by the firstvirtual arch element and the first one or more virtual tooth engagementstructures.
 6. The method of claim 5, further including wherein themethod further includes defining a space between two virtual teeth or avirtual tooth and another feature of a patient's mouth based upon acalculated movement of an arch of the patient accomplished by one ormore estimated forces applied by the first virtual arch element and thefirst one or more virtual tooth engagement structures and designing thesecond virtual tooth engagement structures to maintain the definedspace.
 7. The method of claim 1, further including forming a physicalarch element based on the virtual arch element, and forming one or morephysical tooth engagement structures connected to the physical archelement.
 8. A method of forming a dental appliance, comprising: forminga virtual arch element based on a virtual dental arch of a patient,wherein the virtual arch element is wider than an arch width of thevirtual dental arch in accordance with a stage of a treatment plan; andforming one or more virtual tooth engagement structures connected to thearch element, each tooth engagement structure contacting a surface of atooth of the virtual dental arch and imparting a virtual force to thevirtual dental arch.
 9. The method of claim 8, wherein forming the oneor more virtual tooth engagement structures includes forming a shellthat includes a number of cavities formed therein, wherein the number ofcavities are shaped in accordance with one or more teeth of the virtualdental arch.
 10. The method of claim 8, further comprising forming asecond virtual arch element based on the virtual dental arch, whereinthe second arch element imparts a second virtual force to the virtualdental arch according to a second stage of the treatment plan.
 11. Themethod of claim 8, wherein the virtual force is based on maintaining apredefined space between two teeth of the virtual dental arch or a toothand another feature of the virtual dental arch.
 12. The method of claim8, further comprising forming an arch element based on the virtual archelement and one or more tooth engagement structures based on the one ormore virtual tooth engagement structures.
 13. The method of claim 8,wherein forming the virtual arch element comprises forming a corrugatedsurface on the virtual arch element.
 14. The method of claim 8, whereinforming the virtual arch element comprises forming the virtual archelement such that it is releasable from the one or more virtual toothengagement structures.
 15. The method of claim 8, wherein forming thevirtual arch element comprises forming one or more reinforcementstructures on a lingual side of the virtual arch element.
 16. A methodof forming a dental appliance, comprising: forming a virtual archelement that spans a virtual dental arch of a patent, the virtual archelement imparting a virtual force to the virtual dental arch inaccordance with a stage of a treatment plan, the virtual arch elementincluding tooth engagement structures on opposing sides of the virtualarch element and that contact surfaces of opposing teeth of the virtualdental arch.
 17. The method of claim 16, wherein forming the virtualarch element comprises forming the tooth engagement structures to extendaround to a buccal side of the virtual dental arch.
 18. The method ofclaim 16, wherein forming the virtual arch element comprises defining awidth of the virtual arch element to be wider than an arch width of thevirtual dental arch.
 19. The method of claim 16, wherein forming thevirtual arch element comprises defining a width of the virtual archelement to be narrower than an arch width of the virtual dental arch.20. The method of claim 16, wherein forming the virtual arch elementincludes forming a corrugated surface on the virtual arch element.